Minimally invasive surgical assembly and methods

ABSTRACT

A minimally invasive surgical assembly broadly includes an outer hollow needle which has an outer diameter of approximately 2 mm or smaller, and a coaxial surgical instrument having a shaft which extends through the outer hollow needle. The coaxial surgical instrument includes end effectors at the end of the shaft which are biased to an open position such that when the end effectors of the surgical instrument extend out of the needle they open, and they are closed by relative movement of the needle over them. The assembly preferably includes a first fixing element which is used to fix the relative location of the surgical instrument and the needle. The assembly also preferably includes a second fixing element which moves relative to the needle and is located on the outside thereof and which is used to fix the relative location of the needle to the patient.

This application is a continuation application of U.S. patentapplication Ser. No. 11/420,927, filed May 30, 2006, now U.S. Pat. No.7,766,937, and claims the benefit of priority from U.S. Patentapplication Ser. No. 60/781,556 filed Mar. 13, 2006, each of whichapplications is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates broadly to surgical instruments and methods oftheir use. More particularly, this invention relates minimally invasivesurgical instruments incorporating a needle and a working device whichextends through and beyond the needle and which can be retracted intothe needle. The invention has particular application tolaparoscopic-type surgery, although it is not limited thereto.

2. State of the Art

Over the last two decades, minimally invasive surgery has become thestandard for many types of surgeries which were previously accomplishedthrough open surgery. Minimally invasive surgery generally involvesintroducing an optical element (e.g., laparoscope or endoscope) througha surgical or natural port in the body, advancing one or more surgicalinstruments through additional ports or through the endoscope,conducting the surgery with the surgical instruments, and withdrawingthe instruments and scope from the body. In laparoscopic surgery(broadly defined herein to be any surgery where a port is made via asurgical incision, including but not limited to abdominal laparoscopy,arthroscopy, spinal laparoscopy, etc.), a port for a scope is typicallymade using a surgical trocar assembly. The trocar assembly oftenincludes a port, a sharp pointed element (trocar) extending through andbeyond the distal end of the port, and at least in the case of abdominallaparoscopy, a valve on the proximal portion of the port. Typically, asmall incision is made in the skin at a desired location in the patient.The trocar assembly, with the trocar extending out of the port is thenforced through the incision, thereby widening the incision andpermitting the port to extend through the incision, past any facie, andinto the body (cavity). The trocar is then withdrawn, leaving the portin place. In certain circumstances, an insufflation element may beattached to the trocar port in order to insufflate the surgical site. Anoptical element may then be introduced through the trocar port.Additional ports are then typically made so that additional laparoscopicinstruments may be introduced into the body.

Trocar assemblies are manufactured in different sizes. Typical trocarport sizes include 5 mm, 10 mm and 12 mm (available from companies suchas Taut and U.S. Surgical), which are sized to permit variously sizedlaparoscopic instruments to be introduced therethrough including, e.g.,graspers, dissectors, staplers, scissors, suction/irrigators, clamps,forceps, biopsy forceps, etc. While 5 mm trocar ports are relativelysmall, in some circumstances where internal working space is limited(e.g., children), it is difficult to place multiple 5 mm ports in thelimited area. In addition, 5 mm trocar ports tend to limit movements ofinstruments inside the abdominal cavity to a great extent.

Further, while laparoscopic surgery has reduced the trauma associatedwith various surgical procedures and has concomitantly reduced recoverytime from these surgeries, there always remains a desire in the art tofurther reduce the trauma to the patient.

One area of trauma associated with laparoscopic surgery identified bythe inventor hereof as being susceptible of reduction are the scarswhich result from the trocar ports used. In many laparoscopic surgeries,three or more trocar incisions are made. For example, in laparoscopichernia repair surgery, four trocar incisions are typically made, withone incision for insufflating the abdomen and inserting the opticaldevice, two incisions for trocar ports for inserting grasperstherethrough, and a fourth port for passing a stapler therethrough.Those skilled in the art and those who have undergone surgicalprocedures recognize that even the 5 mm trocar ports leave holes whichmust be stitched and which result in scars.

A second area of trauma associated with laparoscopic surgery identifiedby the inventor hereof as being susceptible of reduction relates totrauma resulting from the manipulation (angling) of the trocar portsrequired in order to conduct the surgery due to inexact placement.Angling of the port can cause tearing at the incision periphery.

Those skilled in the art will also appreciate that because of the numberof trocar assemblies and laparoscopic tools used in laparoscopic surgery(most of which are disposable because of the cost and complicationsassociated with autoclaving), the cost of laparoscopic surgery is high.Thus, there always remains a desire in the art to provide lower costlaparoscopic tools.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide a minimallyinvasive surgical assembly which reduces trauma to the patient relativeto presently used systems.

It is another object of the invention to provide a minimally invasivesurgical assembly which is simple and inexpensive relative to presentlyused systems.

It is a further object of the invention to provide a minimally invasivesurgical assembly which utilizes a 2 mm or smaller incision/port device.

It is also an object of the invention to provide a minimally invasivesurgical assembly which will not scar a patient.

It is an additional object of the invention to provide a minimallyinvasive surgical assembly utilizing effective surgical instrumentswhich are inserted into a 2 mm or smaller port device.

It is still another object of the invention to provide a minimallyinvasive surgical assembly with reduced number of parts.

In accord with these objects, which will be discussed in detail below, aminimally invasive surgical assembly according to the invention broadlyincludes an outer hollow needle which has an outer diameter ofsubstantially 2 mm or smaller (the term “substantially”, for purposes ofthis application meaning ±10%), and a coaxial surgical instrument havinga shaft which extends through the outer hollow needle. The coaxialsurgical instrument includes end effectors at the end of the shaft whichare biased to an open position such that when the end effectors of thesurgical instrument extend out of the needle they open, and they areclosed by relative movement of the needle over them. The assemblypreferably includes a first fixing element which is used to fix therelative location of the surgical instrument and the needle. Theassembly also preferably includes a second fixing element which movesrelative to the needle and is located on the outside thereof and whichis used to fix the relative location of the needle to the patient. Thesecond fixing assembly may include an achoring element which permits theneedle to be held at different angles relative to the patient.

According to one embodiment of the invention, the surgical instrumentand needle are sized so that at least a portion of the shaft of thesurgical instrument interferingly slides against the inner surface ofthe needle, thereby forming a seal which is effective againstdesufflation.

The surgical assembly of the invention may be used during laparoscopicsurgery instead of using an extra trocar and laparoscopic instrument. Inparticular, with the surgical instrument (e.g., grasper) partiallyinserted in the needle (i.e., with the end effectors at least partiallywithdrawn inside the needle) and optionally locked relative to eachother by the first fixing element, the needle is used to puncture theskin and advance into the body (e.g., the abdomen). At a desiredlocation (typically under guidance of an already inserted scope), themovement of the needle is stopped. The surgical instrument is thenunlocked (if previously locked) and advanced until the end effectorsextend past the needle and spring open. The needle and surgicalinstrument may then further advanced until the end effectors extend overa structure in the body. Then, with the surgical instrument stationary,the needle is advanced relative to the surgical instrument to force theend effectors closed, thereby securely grasping the structure. The firstfixing element may then be used to fix the needle relative to thesurgical instrument to prevent release of the grasped structure. Ifdesired, the needle with the surgical instrument fixed relative theretoand grasping the structure may be manipulated relative to the body wall(e.g., to lift, push, or otherwise move the structure). When the needle(or the grasped structure) is in a desired location in the body, thesecond fixing element is slid along the needle and into engagement withthe skin of the patient, thereby fixing the grasping end effectors at adesired location in the body. At any time, the grasped structure can bereleased by causing the first fixing element to release the surgicalinstrument and then moving the needle backward relative to the surgicalinstrument, thereby permitting the end effectors to reopen. The surgicalassembly can be pulled out of the body (preferably with the surgicalinstrument first moved backward relative to the needle to retract andclose the end effectors and locate them inside the needle) leaving justa small puncture mark which will often heal without a scar.

The surgical assembly of the invention thereby accomplishes the objectsof the invention with a minimum number of parts and may be used toreplace expensive trocar assemblies and laparoscopic instruments.

Additional objects and advantages of the invention will become apparentto those skilled in the art upon reference to the detailed descriptiontaken in conjunction with the provided figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an enlarged broken cross sectional view of a first embodimentof the surgical assembly of the invention with the end effectors of thesurgical instrument in an open (advanced) position.

FIG. 2 is an enlarged broken cross sectional view of a first embodimentof the surgical assembly of the invention with the end effectors of thesurgical instrument in a closed (retracted) position.

FIGS. 3A-3E are broken representations of five different fixing elementsystems for fixing the shaft of surgical instrument relative to theneedle.

FIG. 4 is a representation of a first embodiment of an anchoring elementfor fixing the location of the surgical assembly relative to thepatient.

FIGS. 5A and 5B are respective top and side views of another embodimentof an anchoring element for fixing the location of the surgical assemblyrelative to the patient.

FIG. 6 is a schematic view of another mechanism fixing the location ofthe surgical assembly relative to the patient.

FIGS. 7A-7G are representations of seven different end effectors for thesurgical instrument of the invention.

FIG. 8A-8D are representations of a modified surgical instrument havingend effectors acting as an obturator, and with the end effectors locatedin a—rest shielding position, a puncturing position, an extendedposition, and a withdrawn position respectively.

FIGS. 9A-9D are schematic diagrams showing the use of four surgicalassemblies of the invention being used for a hernia repair operation.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A minimally invasive surgical assembly 10 according to the invention andas seen in FIGS. 1 and 2 broadly includes an outer hollow needle 12which has an outer diameter of substantially 2 mm (0.008 inches) orsmaller, and a coaxial surgical instrument 14 having a shaft 15 whichextends through the outer hollow needle. The needle 12 has a sharpeneddistal end 18 which is angled at about 35° relative to a longitudinalaxis of the needle, and a proximal end having a knob or handle 20 forholding and manipulation of the needle. The inside diameter of theneedle is approximately 1.5 mm (0.006 inches) and the wall thickness ofthe needle is approximately 0.25 mm (0.001 inch). The needle istypically between 10 and 30 cm long, and more typically between 13 and18 cm long (although other sizes could be used, depending upon thesurgery involved, and typically larger for obese patients and smallerfor infants and small children), and is preferably made from stainlesssteel, although other materials could be utilized.

The coaxial surgical instrument 14 shown in FIGS. 1 and 2 is a graspertype instrument and includes end effectors 22 at the distal end of theshaft 15 and a handle or knob 24 at the proximal end of the shaft. Theend effectors 22 are formed so that they are biased to an open positionas seen in FIG. 1, such that when the end effectors 22 of the surgicalinstrument 14 extend out of the needle 12 they open, and when the needleextends over them as in FIG. 2, they close. The end effectors 22 may beformed from the end of the shaft 15 as described in U.S. Pat. No.6,616,683 to Toth et al. which is hereby incorporated by referenceherein in its entirety, or in any other desired manner such as byforming end effectors and connecting them to the shaft. The shaft 15 ofthe surgical instrument 14 must be long enough to permit the endeffectors to extend out of the needle as seen in FIG. 1. The surgicalinstrument 14 is preferably made from stainless steel, although othermaterials could be utilized for all or part of the instrument 14.

According to one aspect of the preferred embodiment of the invention,the surgical instrument 14 and needle 12 are sized so that at least aportion of the shaft 15 of the surgical instrument 14 interferinglyslides against the inner surface of the needle 12, thereby forming aseal which is effective against desufflation. Thus, the outer diameterof the shaft 15 is approximately 1.49 mm (0.0059 inches), or about 0.01mm smaller than the inner diameter of the needle. This small differencein diameters results in a sliding interference fit which can be felt asa drag and which effectively acts as a seal against desufflation. Ifdesired, only a portion of the shaft can be sized to interferingly slideagainst the inner surface of the needle. Alternatively, the needle mayinclude an internal gasket or seal which seals against the outerdiameter of the shaft.

Turning to FIGS. 3A-3E, according to the preferred embodiment, theassembly 10 of the invention includes a first fixing mechanism, element,or system which is used to fix the relative location of the surgicalinstrument 14 and the needle 12. In FIG. 3A, the a first fixing system50 is shown to include notches 52 on the shaft 15 of the surgicalinstrument 14, and a screw 54 which extends through a threaded radialhole 55 in the needle 12 or its handle. When it is desired to fix thesurgical instrument 14 relative to the needle 12, the screw 54 isscrewed (typically clockwise) into the needle and into engagement with anotch 52. When it is desired to release the surgical instrument 14, thescrew 54 is unscrewed so that it is no longer engaged in the notch. Itwill be appreciated that instead of a screw 54 and a threaded radialhole 55, a spring loaded pin which extends through a radial hole in theneedle (or needle handle) could be utilized to lock the surgicalinstrument 14 relative to the needle 12.

In FIG. 3B, a second fixing system 50′ is shown to include radialgrooves 60 on the shaft 15 of the surgical instrument and a clip 61having spring arms 62 (one shown), and a shaft 63. The shaft 63 of theclip 61 extends through a wall of the needle or, more preferably, itshandle, and the spring arms 62 engage a radial groove 64 on the shaft15. When the shaft 15 of the needle is pushed or pulled relative to theneedle, the spring arms 62 spread to permit movement of the shaft 15past the clip 61. It will be appreciated that if the spring arms 62 aresufficiently springy, grooves are not required on the shaft 15 of theneedle as the spring arms 62 will firmly hold the shaft in position.

A third fixing system 50″ is seen in FIG. 3C and includes a plasticscrew 65 which extends around the shaft 15 of the surgical instrument14, and an inner thread 66 located on the handle or knob 20 of theneedle 12. When it is desired to fix the surgical instrument 14 relativeto the needle 12, the screw 65 is screwed into the threaded handle orknob needle 20 of the needle 12. The plastic screw 65 and the innerthread 66 of the handle or knob 20 of the needle are sized to cause theplastic screw 65 to deform and tighten around the shaft 15 when thescrew 65 is screwed into the thread 66, thereby fixing the locations ofthe needle 12 and surgical instrument 14 relative to each other. When itis desired to release the surgical instrument 14, the screw 65 isunscrewed sufficiently to permit movement of the surgical instrumentrelative to the needle. As will be appreciated by those skilled in theart, the screw 65 may have a gripping member such as a head (not shown)to help the practitioner apply torque.

FIG. 3D shows a fourth fixing system 50′″ which includes a thumb screw70 and a handle portion 20 of the needle 12 which includes a thread (notshown), and which is flexible or plastic. In particular, the thumb screw70 when screwed onto the handle portion threads causes the handleportion to clamp down on the shaft 15 of the surgical instrument 14 andlock the surgical instrument relative to the needle.

A fifth fixing system 50″″ is seen in FIG. 3E where a cam element 72 isrotatingly coupled to the needle handle 20′ by a pin 73. When in a firstorientation, the cam element 72 permits a rear portion 15′ of the shaft15 of the surgical instrument 14 to move in an uninhibited manner. Whenin a second orientation as shown in FIG. 3E, the cam element 72 engagesthe rear portion 15′ of the shaft 15 and holds it fixed relative to theneedle handle 20′ and needle 12. It will be appreciated that in additionto the fixing system 50″″ which is different the fixing systems of FIGS.3A-3D, the needle handle 20′ and surgical instrument handle 24′ aremodified relative to the handles 20, 24 shown in FIGS. 1 and 2 and FIGS.3A-3D.

The assembly also preferably includes a second fixing element whichmoves relative to the needle and is located on the outside thereof andwhich is used to fix the relative location of the needle to the patient.More particularly, as seen in FIG. 4, the second fixing element is asoft plastic suction cup 80 which engages and is frictionally slidableover the outer surface of the needle 12, and which can be pressedagainst the abdominal wall of a patient to cause a suction connection.If desired, the outer surface of the needle 12 may be provided withmating elements such as bumps, serrations, or grooves (not shown), andthe suction cup 80 may be provided with a reciprocal mating element (notshown) for engaging the mating element of the outer surface of theneedle 12 to more strongly fix the location of the suction cup 80relative to the needle 12.

Turning to FIGS. 5A and 5B, a second embodiment of the second fixingassembly is seen to include a plastic suction cup 80′ having a topproximal hole 82 and a plurality of bayonet-type grooves 84 throughwhich the needle 12 can be maneuvered. The suction cup 80′ therebypermits the needle 12 to be held at different angles relative to thepatient.

In lieu of a suction cup, it is possible to fix the location of theneedle 12 and surgical instrument 14 relative to the patient by usingstandard equipment and modifying the surgical assembly of the inventionslightly. Thus, as seen in FIG. 6, a standard multiheaded clip 90 isprovided which is fixed by a clamp 92 to the side of an operating roomtable. The multiheaded clip 90 includes a malleable metal rod 94 and aplurality of clip elements 96. The surgical assembly 10 may then be heldin a desired position relative to the patient by providing the needle 12or surgical instrument 14 with a clip receiver or groove which may belocated on the outside surface of the needle handle or on the handle orknob of needle or surgical instrument.

As will be appreciated by those skilled in the art, the surgicalinstrument 14 of the invention may take various forms. Thus, FIGS. 7A-7Gshow representations of seven different end effectors for the surgicalinstrument of the invention (although others could be utilized). FIG. 7Ashows a detailed view of a grasper such as seen in FIGS. 1 and 2. Thegrasper end effectors 101 include two arms 102 which extend from shaft15, each of which is approximately 19 mm (0.75 inch) long. The arms areslightly rounded on their outer peripheries in the same profile as theshaft 15, with each rounded surface forming an arc of between forty-fiveand ninety degrees. The first portions 104 (e.g., about 4 mm) of thearms are relatively straight in their at rest open position. The middleportions 106 of the arms 102 then angle away from each other (each atbetween 6° and 18°, and most preferably at about 12° from thehorizontal) until they extend approximately 7 mm apart from each other.In order to provide a good spring load, the middle portions of the armsmay be reinforced with or formed from spring steel. The tips 108 (e.g.,approximately 3 mm) of the arms are then bent back to parallel the firstportions 104. Their outer surfaces may also be flattened.

If desired, the grasper of FIG. 7A can be formed from a solid rod or atube of steel, by cutting the end of the tube in half to form arms(e.g., via use of a laser or an EDM machine), further removing materialfrom the underside of each arm at the first portions 104, and thenbending the arms at the intersections of the first portions 104 andmiddle portions 106, and at the intersections of the middle portions 106and tips 108.

FIG. 7B is a representation of lung clamp end effectors 111. The lungclamp end effectors extend from the shaft 15 with arms 112 whichterminate in loops 114 which define openings 115. While not shown indetail in FIG. 7B, the arms 112 are similar to the arms of the grasperof FIG. 7A in that they are slightly rounded on their outer peripheriesin the same profile as the shaft 15, include first portions 116 whichare relatively straight in their at rest open position and middleportions 118 which angle away from each other until they extendapproximately 6 mm apart from each other. The loops 114 are then bentback to parallel the first portions 116. In order to provide a goodspring load, the middle portions of the arms may be reinforced with orformed from spring steel.

FIG. 7C is a representation of hybrid end effectors 121 including onegrasper 122 and one lung clamp 123. The grasper 122 is substantially asdescribed above with reference to FIG. 7A, and the lung clamp 123 issubstantially as described above with reference to FIG. 7B.

FIG. 7D is a representation of non-crushing clamping end effectors 131including one grasper 132 and a rubber covered arm 133.

FIG. 7E is a representation of retractor end effectors 141. Theretractor end effectors 141 are formed from wire mesh elements 143 whichat rest are substantially flat, but which are bent into an arcuate shapewhen retracted into the needle.

FIG. 7F is a representation of a grasper similar to that of FIG. 7A. Theprimary differences between the grasper end effectors 151 of FIG. 7F andthe grasper end effectors 101 of FIG. 7A are that the arms 152 are eachapproximately 25 mm (1 inch) long, the middle portions 156 angle awayfrom each other (at about 50° or 25° from the horizontal) until theyextend approximately 10 mm apart from each other, and the tip portions158 are approximately 12 mm long and bend back slightly beyond beingparallel to the first portions 154 so that they are angled slightlytoward each other.

FIG. 7G is a representation of a crushing grasper 161 shown in a closedposition within a needle 12. The crushing grasper 161 is similar to thegrasper 101 of FIG. 7A except that it is slightly longer (approximately22 mm long), and the tip portions 168 have teeth 169 a and have arounded front 169 b such that they present a blunt almost hemisphericalsurface. When the end effectors 161 of FIG. 7G are moved forwardrelative to the needle 12, they preferably remain in a closed positionuntil approximately half the length of the arms 162 extend beyond theneedle. Thus, as will be discussed below, the end effectors of thesurgical instrument 14 may act as an obturator relative to the needle toguard the needle from causing accidental needle tip trauma.

The surgical assemblies of the invention may be used during laparoscopicsurgery instead of using extra trocars and laparoscopic instruments. Inparticular, with the surgical instrument 14 (e.g., grasper end effectors111) partially inserted in the needle 12 (i.e., with the end effectorswithdrawn at least partially inside the needle) and optionally lockedrelative to each other by the first fixing element (e.g., fixing system50), the needle 12 is used to puncture the skin and advance into thebody (e.g., the abdomen). At a desired location (typically underguidance of an already inserted scope), the movement of the needle isstopped. The surgical instrument 14 is then unlocked (if previouslylocked) and advanced until the end effectors 111 extend past the needle12 and spring open. The needle and surgical instrument may then furtheradvanced until the end effectors extend over a structure in the body.Then, with the surgical instrument stationary, the needle is advancedrelative to the surgical instrument to force the end effectors 111closed, thereby securely grasping the structure. The first fixingelement or system (e.g., system 50) may then be used to fix the needlerelative to the surgical instrument to prevent release of the graspedstructure. If desired, the needle with the surgical instrument fixedrelative thereto and grasping the structure may be manipulated relativeto the body wall (e.g., to lift, push, or otherwise move the structure).When the needle (or the grasped structure) is in a desired location inthe body, the second fixing element (e.g., 80) is slid along the needleand into engagement with the skin of the patient, thereby fixing thegrasping end effectors at a desired location in the body. At any time,the grasped structure can be released by causing the first fixingelement to release the surgical instrument and then moving the needlebackward relative to the surgical instrument, thereby permitting the endeffectors to reopen. The surgical assembly can be pulled out of the body(preferably with the surgical instrument first moved backward at leastpartially relative to the needle to retract and close the end effectors)leaving just a small puncture mark which will often heal without a scar.

It is noted that because of the small diameter of the surgical assembly,withdrawal of the needle assembly from the abdomen will not causedesufflation, and should not require stitching to close the wound. It isalso noted that because of the small diameter of the surgical assemblythe elimination of a trocar port, the surgical assembly can be easilymoved in any direction (i.e., it can be easily angled) during surgery.

The surgical assembly of the invention thereby accomplishes the objectsof the invention with a minimum number of parts and may be used toreplace expensive trocar assemblies and laparoscopic instruments.

According to another aspect of the invention, as previously mentioned,the tips of the end effectors of the surgical instrument may be used tofunction as an obturator. Thus, as seen in FIGS. 8A-8D, a surgicalassembly combining aspects seen in FIGS. 3E and 7G is shown, except thata spring 193 is provided and coupled to the handles 20′, 24′ of theneedle and surgical instrument respectively. Spring 193, in an at restposition, causes the rounded end effectors 161 to assume a positionwhere the end effectors extend out of the needle 12 but remain in aclosed position as seen in FIG. 8A. In this partially extended position,the end effectors 161 act as an obturator or protection from accidentalneedle tip trauma. When the surgical assembly is used to puncture skinas seen in FIG. 8B, pressure is placed on the end effectors, therebycausing the end effectors 161 to be pushed back into and therebyexposing the needle, and causing the surgical instrument to movebackward relative to the needle, thereby placing spring 193 undertension. When the skin is punctured and the needle extends into a cavityand pressure on the end effectors is released, the spring 193 pushes thesurgical instrument forward to reassume the position of FIG. 8A. When itis desired to extend the end effectors 161 to grasp a structure, thesurgical instrument may be pushed forward relative to the needle as seenin FIG. 8C, thereby placing the spring 193 under compression, andopening the end effectors 161. The end effectors may then be closed overthe object by pulling end effectors backward relative to the needlewhereby the needle acts on the end effectors to at least partially closethem, with the spring 193 assuming a partially compressed position. Thegrasping position (and any other position) may be locked at any timeusing the fixing element (e.g., cam 72). If it is desired to pull theend effectors totally into the needle as seen in FIG. 8D, that may beaccomplished by pulling the surgical instrument backward relative to theneedle, again placing the spring 193 in tension. The surgical instrumentcan be locked in that position using the fixing element.

Use of a plurality of surgical assemblies 10 a-10 d is seen in FIGS.9A-9D with respect to a hernia repair operation. In particular, anabdominal wall 200 is seen with a hernia (opening) 290. The hernia 290is to be repaired with mesh 290 which has been inserted into the abdomenunder guidance of a laparoscope (not shown). As seen in FIG. 9A, foursurgical assemblies 10 a-10 d according to the invention have been usedto pierce the abdominal wall. The four assemblies 10 a-10 d are thenused to grasp corner areas of the mesh 295 by moving the grasper endeffectors out of their respective needles and over and around the meshcorners, and by moving the needles forward relative to the grasperinstruments to force the end effectors closed over the mesh. The needlesand surgical instruments are then preferably locked relative to eachother (using first fixing mechanisms or systems such as discussed abovewith reference to FIGS. 3A-3E), and the assemblies 10 a-10 d are pulledupward to cause the mesh 295 to lie directly below the hernia 290 asseen in FIG. 9B. The assemblies are then preferably locked in placerelative to the abdominal wall using mechanisms such as discussed abovewith reference to FIGS. 4, 5A, 5B, and 6. Then, using a laparoscopicstapler (not shown) typically introduced through a standard trocar port,the mesh is stapled in place. The mesh may then be released by theassemblies 10 a-10 d by unlocking the surgical instruments, unlockingthe second fixing mechanisms, and moving the respective needles backwardin order to open the end effectors. After the mesh is released, the endeffectors of the surgical instruments are withdrawn at least partiallyinto the needles (and optionally locked in place), and withdrawn fromthe abdomen, leaving the mesh 295 stapled in place as seen in FIGS. 9Cand 9D.

It will be appreciated by those skilled in the art that the minimallyinvasive surgical assemblies of the invention can be used for variousother surgical procedures, including but not limited to tuboplasty,gastric bypass, bowel connection, kidney surgery, appendectomy,menisectomy, discectomy, etc. The minimally invasive surgical assembliesof the invention also have particularly advantageous use in neonatal andpediatric surgeries.

There have been described and illustrated herein several embodiments ofa minimally invasive surgical assembly and methods for the use thereof.While particular embodiments of the invention have been described, it isnot intended that the invention be limited thereto, as it is intendedthat the invention be as broad in scope as the art will allow and thatthe specification be read likewise. Thus, while particular materials formaking the needle and surgical instrument have been disclosed, it willbe appreciated that other materials may be used as well. In addition,while particular fixing elements and systems have been disclosed forfixing the surgical instrument relative to the needle, it will beunderstood that other mechanisms can be used. For example, and not byway of limitation, a latch-catch system can be used. Also, whileparticular fixing elements and systems for fixing the location of thesurgical assembly relative to the patient have been described, it willbe recognized that other mechanisms can be used for that as well.Furthermore, while particular end effectors such as graspers, lungclamps, etc., have been described for the surgical instrument, it willbe understood that instruments with different end effectors such as (butnot limited to) dissectors, staplers, scissors, suction/irrigators,clamps, biopsy forceps, etc., an be similarly used. Also, the arms ofthe end effectors need not be of equal length. Further, while thesurgical instrument and needle have been shown as being straight,because of their small diameter they may be bent together by the user,or one or both may be formed with a bend (arc). Moreover, whileparticular configurations have been disclosed in reference to thehandles of the surgical instrument and the needle have been disclosed,it will be appreciated that other configurations could be used as well.In addition, while the needle was described as being a particular sizeand having a sharp end with a certain angle, it will be appreciated thatother size needles can be used and the sharp can be at different angles.It will therefore be appreciated by those skilled in the art that yetother modifications could be made to the provided invention withoutdeviating from its spirit and scope as claimed.

What is claimed is:
 1. A surgical device comprising: an elongated needlebody defining an interior lumen extending longitudinally therethrough,the needle body having a sharpened distal tip portion; and an interiorsurface profile which defines the interior lumen; a handle attached to aproximal end of the enlongated needle body; and an assembly operativelyassociated with the interior lumen of the needle body, the assemblyhaving: a solid metallic shaft having an outer surface profilecorresponding to the inner surface profile of the needle body, the shaftextending through the interior lumen needle body and defining alongitudinal axis and a pair of arms extending distally from the shaft,and biased radially outwardly from the longitudinal axis of the shaft,each arm having a first portion extending generally parallel to alongitudinal axis of the shaft, a middle portion extending distally froma distal end of the first portion and angled away from the longitudinalaxis of the shaft, and a tip portion extending distally from the distalend of the middle portion and substantially parallel to the firstportion, and having a blunt front surface, wherein proximal movement ofthe shaft causes approximation of the arms to a closed position in whichthe arms intimately contact one another along the entire length thereof,wherein the arms are adapted and configured so as to remain in theclosed position in intimate contact with one another within the interiorlumen of the needle body until approximately half the length of the armsextend beyond the sharpened distal tip portion of the needle body, andthe blunt front surfaces of the tip portions of the arms are rounded andtogether present an approximately hemispherical surface in the closedposition adapted and configured to act as an obturator relative to thesharpened distal tip portion of the needle body and guard the needlebody from causing accidental needle tip trauma when the arms areextended approximately half the length of the arms beyond the sharpeneddistal tip portion of the needle body, wherein the arms are furtheradapted and configured to separate from one another from the closedposition as the arms are extended more than approximately half theirlength beyond the sharpened distal tip position of the needle body, andwherein the handle rotatably supports a first fixing means, the firstfixing means including a cam element operable to lock an axial positionof the assembly with respect to the needle body.
 2. The surgical deviceof claim 1, wherein the outer surface profile of the shaft is sized tointerferingly fit against the inner surface profile of the needle bodyto inhibit fluid communication therebetween, to avoid loss ofinsufflation gas from an operative space.
 3. The surgical device ofclaim 1, wherein a seal is provided between the shaft and the innersurface of the needle body to inhibit fluid communication therebetween,to avoid loss of insufflation gas from an operative space.
 4. Thesurgical device of claim 1, further comprising a second fixing meansadapted and configured to stabilize the surgical device with respect toan operative space of a patient.
 5. The surgical device of claim 1,wherein the elongated needle body is between about 13 cm and 18 cm inlength.
 6. The surgical device of claim 1, wherein an outer diameter ofthe elongated needle body is about 2 mm or less.
 7. The surgical deviceof claim 1, wherein the assembly is configured such that the arms, in anopen position, are separated by a distance greater than two times adiameter of the elongated needle body.
 8. The surgical device of claim1, wherein the assembly is configured such that the arms, in an openposition, are separated by a distance of between about 7 mm and about 12mm.
 9. The surgical device of claim 1, wherein the middle portion ofeach arm extends away from the longitudinal axis of the shaft by anangle of between about 6 degrees and about 18 degrees.
 10. The surgicaldevice of claim 1, wherein the sharpened distal tip portion includes asharpened end surface angled at about 35 degrees with respect to thelongitudinal axis.
 11. The surgical device of claim 1, furthercomprising a handle in connection therewith to facilitate manipulationof the device.
 12. The surgical device of claim 1, wherein the arms areconfigured as a surgical grasper.
 13. The surgical device of claim 1,wherein the arms are configured as a lung clamp.
 14. The surgical deviceof claim 1, wherein the arms are configured as a retractor.
 15. Thesurgical device of claim 1, wherein the arms are integrally formed withthe shaft.
 16. The surgical device of claim 1, wherein the arms areconnected to the shaft.
 17. The surgical device of claim 1, wherein anouter diameter of the elongated needle body is about 1.8 mm to about 2.2mm.
 18. The surgical device of claim 1, further comprising a springcoupled between the handle and a proximal end of the shaft, wherein thespring is placed in a state of tension as the pair of arms are retractedwithin the elongated needle body to reveal the sharpened distal tip in apuncturing position, and wherein the spring is placed in a state ofcompression as approximately half the length of the arms are extendedbeyond the sharpened distal tip in an extended position.
 19. Thesurgical device of claim 1, further comprising a spring coupled betweenthe handle and a proximal end of the shaft, wherein the spring biasesthe pair of arms to extend beyond the sharpened distal tip while keepingthe pair of arms in the closed position.
 20. The surgical device ofclaim 1, wherein the cam includes a rounded surface to contact and tolock an axial position of an outer surface of the shaft relative to thehandle.